What happens to sexuality of women during
lactation period? A study from Iran

Masoumeh Heidari1, Effat Merghati Khoei2,
Azita Kiani Asiabar3

ABSTRACT

Objective: To compare the
association of sexual activity and breastfeeding women within 2-6 months after
child birth.

Methodology: This study was carried out
in 2007. The sexual activity of 258 breastfeeding women was compared with 198
bottle-feeding women referred to a public maternity health care center in
Tehran. Women in the age of 20-35 years were enrolled in the study after their
first or second child and 2-6 months after birth. A self-structured
questionnaire was used for data collection. Women were interviewed
face-to-face by the first author.

Results: Of 456 respondents, 258 were
currently breastfeeding and 198 were bottle feeding. Mean age of the mothers
was 27±4.7 years. About 28.3% of breastfeeding women and 22.9% of non
breastfeeding women had sexual intercourse within one month of postpartum
period. No significant difference was found between breastfeeding and
bottle-feeding women on sexual desire and satisfaction before pregnancy and in
postpartum period (p: 0.1, p: 0.5).The orgasm experience did not have a
significant difference between the two groups during postpartum (p: 0.4).

Conclusion: We did not find significant
difference in sexual activity between breastfeeding and non-breastfeeding
women. Sexual history taking and counseling in antenatal class as well as
postpartum period are suggested for the clients.

There are specific effects during pregnancy and Post-partum
period affecting women’s sexual lives. The majority of women reported a
decline in sexual activity and interests during pregnancy as well as lactation
period.

1
There are also other changes both physiological and psychosocial which affect
women’s sexuality,2-3
and make the explanation of the facts even difficult.1

Common issues affect sexual lives of women such as
dyspareunia due to episiotomy, breastfeeding, vaginal dryness, first mothers
concerns (i.e baby care during night time) and vaginal infections and
bleeding.

4
However the reverse effects of breastfeeding on sexuality of women has
remained. doubtful The studies by Kayner et al have highlighted some negative
impacts of lactation on women’s sexual desire and painful intercourse as well
as feeling fatigue and weakness through their daily life.5
Low rate of sexual desire and activity in postpartum period among nursing
mothers have been reported by a number of studies.6,7
Alison et al pointed out that
lactation is an erotic phenomenon in potential. Other reports show intense
physical exchanges such as skin touching, hands stroking, hormone pulsing and
intimacy-related factor’s.8
In line with this report Master and Johnson confirmed the rapid return of
sexual desire and activities during lactation.9
Like many other societies, in Iran, pregnancy, childbirth and lactation are
considered much more important events in a woman’s life than her sexuality. On
the other hand sexuality is an unspoken issue in general and is undermined
during pregnancy and lactation in particular.

In this study we aimed to compare two groups of women:
breastfeeding and bottle-feeding in their sexual desire, satisfaction,
activity (frequency of intercourse) and time of resumption in 2-6 months after
childbirth.

METHODOLOGY

This causal-comparative study was carried out from April to
December in 2008. Two groups of women: breastfeeding (n= 258); bottle-feeding
(n= 198) were enrolled in this study. These women were matched in age (20-35
years old); postpartum period (2-6 months after delivery); and parity (1

st
or 2nd
pregnancy). All women were interviewed by the first author in a public
maternity health care center.

The study protocol was approved by research ethics
committee of Shahed University and informed consent was obtained from all
participants before enrollment. Study population consisted of (case) and
(control) women. The time of resumption of sexual intercourse, number of
intercourses in a month, sexual desire and satisfaction and experience of
orgasm and dyspareunia and vaginal dryness were compared between the two
groups. Sample size calculated according to the pilot study was 243 for case
and control groups. During six months of the study in a public maternity
health care center in Tehran 258 breastfeeding and 198 bottle-feeding women
were selected who fulfilled the inclusion criteria. Women referred to the
clinic 420 breastfeeding women were invited to fill out the questionnaire. Of
420, 258 women with breastfeeding consented to participate in the study. Only
198 women with bottle-feeding from 250 women participated. A trained midwife
interviewed women individually in a private room. All women were explained
about the aim of the study and asked for written consent. The reason for lower
number of bottle feed women is the emphasis on exclusive feeding with breast
milk in the first six months of postpartum.

The questionnaire contained personal characteristics,
socioeconomic condition and questions on sexual activity in postpartum and
context validity method was used to determine the scientific validity of it.
First, the questionnaire was prepared using books and scientific journals and
then asking the opinions of some professors, it was modified. In order to
determine the reliability of the questionnaire in this study, we used
test-retest method. The questionnaire was completed by ten breastfeeding
women. Then ten days later, again they completed the questionnaire and after
data gathering using Pierson test, the correlation coefficient was acquired
98%. So the reliability of the questionnaire was desirable. It must be
mentioned that these ten women were excluded from the study population. The
questions were answered via verbal interview and the data was analyzed using
SPSS and descriptive statistics and Chi

2 test (p<0.05).

RESULTS

Study was carried out on 258 breastfeeding and 198 bottles
feeding women. Breastfeeding women were similar with bottle-feeding in term of
age, occupation, education, socioeconomic condition, parity and type of
delivery (Table-I).

The time of resumption of vaginal intercourse and the
average number of intercourses in a month, sexual desire and satisfaction,
orgasim experience, dyspareunia and vaginal dryness in breastfeeding and
bottle-feeding women during postpartum was compared before pregnancy, is shown
in (Table-II). There was no significant difference between two groups in time
of resumption of vaginal intercourse in postpartum (p: 0.07). There was
significant difference between two groups in frequency of vaginal intercourse
in a month during postpartum (p: 0.02). No significant difference was
indicated between two group’s women on sexual desire in postpartum versus
before pregnancy (p: 0.1). Results showed that in 49.8% of breastfeeding and
43.3% of bottle-feeding women, sexual desire had decreased. Sexual
satisfaction of breastfeed and bottle feeding women during postpartum compared
before pregnancy did not have a significant difference (p: 0.5) so that sexual
satisfaction was decreased in 32.6% of breastfeeding women and 33% of bottle
feeding women. Experience of orgasim did not have a significant difference
between the two groups in postpartum and before pregnancy (p: 0.4) as 65.7% of
breastfeeding women and 64% of bottle feeding women experienced orgasim in
postpartum period. Also no significant deference was found between
breastfeeding and vaginal dryness and also dyspareunia (p: 0.7and p: 0.2,
respectively) so that 43.2% of breastfeeding women and 35.8% of bottle feeding
women had vaginal dryness and 62.4% and 66% had dyspareunia, respectively.

According to the result of breast feeding participants low
sexual desire due to negative effect of breastfeeding on sexual activity was
reported in 81(31.5% ), effect of fatigue caused by breastfeeding on sexual
activity in 98 (38.1%), distortion of body style caused by breastfeeding in
122 (7.47%) and milk discharge during intercourse in 37(14.4%) cases.

We did not give women any instruction about sexual
activity, because we wanted to find out their own experience of sexual and
tension values. Almost 35% of breastfeeding women and 33.9% of non
breastfeeding women stated that they need instructions about sexual activity
in postpartum period.

The results also showed that there is no significant
difference between type of delivery (vaginal and cesarean) and sexual desire
(p: 0.5), satisfaction (p: 0.5), number of intercourses (p:0.4), time of
resumption of sexual activity (p:0.07) and dyspareunia (p: 0.6) during 2-6
weeks postpartum.

DISCUSSION

This study indicated that rather 28.3% of breastfeeding
women and 22.9% of non breastfeeding women resumed their sexual activity in
one month after childbirth and there was not a significant difference between
two group’s women in the time of resumption. In Grudzinsaks and Atkinson study
on 328 breastfeeding women, the resumption was 55.6% after five weeks of
postpartum and there was no significant deference between being breastfeeding
and time of resumption

10
Egbuonu in his research on 178 Nigerian mothers showed that 31.6% of
breastfeeding mothers had resumed vaginal intercourse within six weeks of
postpartum.11

Desgrees-du-lou in his research on breastfeed women during
2000-2001 indicated that mean time for resumption of vaginal intercourse after
delivery was 11 months of postpartum and women were not inclined to resume
sexual activity and they just did it to avoid their husbands making new sexual
relationships.

12
In Connolly’s research on 150 women living in North Carolina about the effects
of delivery on sexual activity, showed that in 6, 12 and 24 weeks of
postpartum 57%, 82% and 90% of women resumed vaginal intercourse.13
Odar in a study on 217 Ugandan women showed that 66.4% women resumed their
sexual activity within six months of postpartum and 22.2% suffered from sexual
disorders in this period14
Woranitat in a research on 80 women studied sexual activity in postpartum. The
results showed that 35% of women had resumed vaginal intercourse within six
weeks of postpartum. Resumption of vaginal intercourse in postpartum did not
have a significant relation with the type of delivery and the most effective
factors in resumption was the husband’s request15
Robson in a longitudinal study on 119 breastfeeding, first child women showed
that 83% resumed vaginal intercourse within six weeks of postpartum and almost
all of them had intercourses in three months of postpartum. It was also
disclosed that the number of intercourses was decreased compared with before
pregnancy.16

The small number of women resuming intercourse during six
weeks of childbirth (breastfeed 28.3%-bottle-feed 22.9%) in our study can be
due to abstinence for six weeks. This is a religious order to avoid sexual
intercourse until six weeks. the period women has vaginal bleeding.

Reported low sexual desire (49.8%) in breastfeeding
participant in this study can be because of poor sexual counseling during
antenatal care but other studies highlighted many factors for breastfeeding
women sexual problem such as vaginal drynees, vertigo, lack of sexual
attractiveness, itching after intercourse.

4,17-19

According to our participants the changes in sexual desire
in breastfeeding and non breastfeeding women in postpartum, showed that 49.8%
and 43.3% had decreased sexual desire respectively comparing with before
pregnancy. Results also showed that sexual satisfaction had decreased in 32.6%
of breastfeeding and 33% of non breastfeeding women. In several studies,
results showed that breastfeeder’s had decreased sexual desire during
postpartum.

5,20-23
The results of this study have a significant difference with those of Master
and Johnson’s who believe that sexual desire in breastfeeding women increases
in postpartum.

Our results showed that 34.4% of breastfeeding and 35.4% of
non breastfeeding women did not experience orgasim in postpartum. The other
studies, showed that breastfeeding women reach orgasim early in postpartum.
However, Master and Johnson believe that lactation causes sexual stimulation
in women and breastfeeding women have the highest sexual desire and ability to
reach orgasim.

13,16
Almost 35% of breastfeeding and 33.9% of non breastfeeding women stated that
they needed some instructions about sexual activity in postpartum. In several
studies, the necessity of sexual consultations in maternity clinics during
postpartum has been confirmed.2,16,23

This study has showed that the type of delivery did not
have a significant deference with sexual activity during postpartum. In
several studies, results showed that there was no significant deference
between the type of delivery and time of resumption of vaginal intercourse and
sexual function (sexual desire, stimulation phase, orgasim and sexual
satisfaction) and women who had vaginal delivery with episiotomy suffered from
more pain during intercourse.

15,
24, 25

CONCLUSION

According to the results of this study, it can be said that
breastfeeding and bottle-feeding women encountered decreased sexual desire and
satisfaction in comparison with before pregnancy because of physiologic,
anatomic and psychological changes in postpartum and there is no significant
difference in the two groups. Therefore offering necessary instructions on
sexual health in postpartum can help improve family sexual health since
inattentiveness to this subject might result in breakup of the family. Here
are some recommendations: